Several activities are included in this program. One activity involves a collaboration with the Diabetes Center of Excellence (DCOE) at Phoenix Indian Medical Center. We collected and analyzed data from a quality improvement project in which nurse case managers were empowered to adjust antihyperglycemic medications in patients with diabetes to more rapidly optimize glycemic control in a system that does not have sufficient capacity for primary care providers to meet its patient care needs.[unreadable] Dr. Knowler participated in a workshop for the American Diabetes Association that resulted in a consensus statement on impaired fasting glucose and impaired glucose tolerance.[unreadable] Dr. Nelson chaired the working group that updated the National Kidney Foundations Kidney Disease Outcome Quality Improvement recommendations for evaluating and treating chronic kidney disease.[unreadable] Dr. Looker analyzed data from the Gila River Indian Community (GRIC) demonstrating that treatment of hypertension, diabetes, and lipid abnormalities have resulted in improved process measures and are likely to result in improved outcomes. This information was presented to the GRIC medical providers as part of a quality improvement project.